EBCN Meeting Budapest, 24 September 2004 Update on individual data monitoring projects
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Transcript of EBCN Meeting Budapest, 24 September 2004 Update on individual data monitoring projects
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EBCN MeetingBudapest, 24 September 2004
Update on individual data monitoring
projects
QT and SEEDAntonio Ponti
CPO PiemonteTorino, Italy
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SEED and QT Audit Systems
Their aim is two-fold:
1) to favour the implementation of European Guidelines (with
training and certification implications), and
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SEED and QT Audit Systems
2) to provide a service to screening programmes and Breast Units to meet their management
and evaluation needs.
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Advantages of monitoringIndividual vs Aggregate
screening data (1)
- Use of common definitions and rules in the process of collecting
the minimum dataset: an “educational” process
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Advantages of monitoringIndividual vs Aggregate
screening data (2)
- Standard analysis of common dataset, including standard reports on European outcome measures
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Advantages of monitoringIndividual vs Aggregate
screening data (3)
- Much more flexible analytical approach
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Projects and Partners (6 Countries)
Center SEED3.8
QT1.1
Bremen Firenze Leuven London Luxembourg Marseille Ravenna Strasbourg Torino Valencia Wiesbaden
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To access SEED (on line)
www.cpo.it/seed
demo has about 100,000 screening episodes
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SEED ResultsSeven European programmes 1999-2001
%
Technical repeat rate 1.8
IM after assessment 1.6
Invasive Ca <= 10 mm 40.5
B / M ratio 0.27
E.G. standard
%
> 25.0
0.6
0.9
38.10.14
E.G. standard
< 1.0
> 30.0
%
124,555 FIRST TESTS 159,511 SUBS. TESTS
%
< 3.0
< 1.0< 1.0
Further assessment rate 6.0 2.9< 7.0 < 3.0
< 0.5 < 0.2
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To download QT
www.cpo.it/qt
www.eusoma.org
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Assessment Episodes Operated lesions
Total 5,513 1,450
10019629
10213096
154109113242No.
1792983400
4541563124042763811664No.
1228ValenciaTorinoStrasbourgRavennaMarseilleLuxembourgLondonLeuvenFirenzeBremenCenter
Wiesbaden
50-Budapest
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0% 20% 40% 60% 80% 100%
Operation within 30 dd.Hormonal rec. available
Grading availableImmediate reconstruction
No axillary diss. in DCISMore than 9 lymph nodes
Clear margins 1 mm.Single operation
Cons. int. in DCIS <21mm.Cons. int. in pT1
No frozen section in Ca <11mmNo failed biopsy
Triple assessmentPreop. diagnosis 67,8
80,399,552,990,387,989,188,389,477,034,299,899,161,3
YES NO
Result %QT outcome measures
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0% 20% 40% 60% 80% 100%
MLIHGFEDCBA 92,4
80,2
88,4
88,1
46,3
13,3
64,8
62,5
66,0
68,1
51,4
181
77
91
96
31
13
46
15
99
32
92
Positive preoperative cyto/histolog. diagnosis
Cancers with post-operative diagnosis
YES ? NO
Results %CENTERCENTER
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0% 20% 40% 60% 80% 100%
MLIHGFEDCBA 92,4
80,2
88,4
88,1
46,3
13,3
64,8
62,5
66,0
68,1
51,4
181
77
91
96
31
13
46
15
99
32
92
Positive preoperative cyto/histolog. diagnosis
Cancers with post-operative diagnosis
YES NO
Results %CENTERCENTER
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0% 25% 50% 75% 100%
A
B
C
D
E
F
G
H
I
L
M
FNA & Core biopsy (operated only)
FNA
?None
BothCBCE
NTE
RCE
NTE
R
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0
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0 20 40 60 80 100 120
B
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Fine Needle AspirationAb
solu
teSe
nsiti
vity
Full Specificity
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0
20
40
60
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100
0 20 40 60 80 100
ABCDEFGILMAll
Pre-operative diagnosisAb
solu
teSe
nsiti
vity
Full Specificity
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0 20 40 60 80 100
A
B
C
D
E
F
G
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L
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Time btw screening and assessment <= 3 weeks
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0 20 40 60 80 100
A
B
C
D
E
F
G
H
I
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M
Time btw referral and surgery <= 30 days
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European Benchmarking
Within the project described we have attempted to bridge guidelines with screening and care evaluation, while providing databases useful for daily
management of screening programmes and patient care.
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European Benchmarking
This could serve as a model for other health care areas, particularly colon
and cervical cancer for which screening programmes are being
offered throughout Europe.
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European Benchmarking
Another bridge is being built: with Cancer Registries networks in the framework of population high
resolution studies.
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European Benchmarking
The quality cycle entails a continuous updating of the audit
tools in the framework of a comprehensive European activity.
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European Benchmarking
In the meanwhile QT is freely available to anyone and SEED could
be used by local and regional screening programmes wishing to
mutually agree to share it and concur in its development.